Document Detail


The role of antiplatelet therapy in acute coronary syndromes and for secondary prevention following a myocardial infarction.
MedLine Citation:
PMID:  8321905     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Acute Coronary Syndromes: Therapy with aspirin is recommended for all patients with acute myocardial ischemic syndromes unless contraindications for its use is present. None of the studies thus far have conclusively established evidence for a selective dose of aspirin. Until conclusive evidence exists, aspirin in doses of 81 mg (children's tablet) to 325 mg (adult tablet) are recommended. Ticlopidine may prove to be an attractive alternate choice in those who cannot take aspirin. According to the ACC/AHA task force recommendations, patients with acute myocardial infarction receiving thrombolytic therapy should receive both heparin and aspirin. Aspirin is to be administered in a dose of 160 mg daily. Heparin can be discontinued after 2 days if the patient's clinical course remains uncomplicated. Aspirin should be continued indefinitely. An alternative strategy in those who cannot take aspirin is to switch to warfarin before hospital discharge with a view toward long-term anticoagulant therapy. Secondary Prevention: Aspirin in a dose of 325 mg daily is recommended for all survivors of an acute myocardial infarction. No benefit derives from the addition of dipyridamole. The role of sulfinpyrazone remains undefined. Warfarin is an effective antithrombotic alternative to aspirin for secondary prevention after a myocardial infarction. However, aspirin is cheaper to administer and follow up when compared with warfarin. From available information, aspirin appears to be an adequate antithrombotic agent in patients who have near-normal left-ventricular function, the elderly, patients with coexisting cerebrovascular or peripheral vascular disease, and those with contraindications for anticoagulants. Warfarin should be preferred in high-risk patients with anterior or apical myocardial infarction, left-ventricular dysfunction with or without a mural thrombus, and those with associated atrial fibrillation. A randomized study assessing aspirin versus warfarin for secondary prevention after myocardial infarction is being initiated to determine the relative efficacy and safety of these drugs in secondary prevention after myocardial infarction.
Authors:
S M Jafri; B Zarowitz; S Goldstein; M Lesch
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Progress in cardiovascular diseases     Volume:  36     ISSN:  0033-0620     ISO Abbreviation:  Prog Cardiovasc Dis     Publication Date:    1993 Jul-Aug
Date Detail:
Created Date:  1993-08-05     Completed Date:  1993-08-05     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0376442     Medline TA:  Prog Cardiovasc Dis     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  75-83     Citation Subset:  AIM; IM    
Affiliation:
Heart and Vascular Institute, Henry Ford Hospital, Detroit, MI 48202.
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MeSH Terms
Descriptor/Qualifier:
Angina, Unstable / drug therapy
Anticoagulants / therapeutic use
Aspirin / therapeutic use
Coronary Disease / etiology,  prevention & control*
Humans
Meta-Analysis as Topic
Myocardial Infarction / complications,  drug therapy*,  prevention & control
Platelet Aggregation Inhibitors / therapeutic use*
Recurrence
Syndrome
Thrombolytic Therapy
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Platelet Aggregation Inhibitors; 50-78-2/Aspirin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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